Overview of the outcomes of robotic segmentectomy and lobectomy

Abstract

Segmentectomy has gained popularity in the latest years as a valid alternative to lobectomy.Initially reserved to patient unfit for lobar lung resection, this procedure is now offered also in selected patient with <2 cm peripheral lung cancer confined to an anatomic segment with no nodal involvement on preoperative evaluation. The introduction of screening with low-dose CT chest scan allowed the identification of lung cancer at early stages, making possible to schedule a more conservative lung surgery.A major improvement came also from minimally invasive surgery (MIS), reducing complication rate with comparable survival rates when compared to open surgery. However, due to long learning curve and uncomfortable instruments handling of video-assisted thoracoscopy, many surgeons still prefer to perform segmentectomies through a thoracotomy and thus increasing perioperative morbidity and leading to postthoracotomy syndrome due to rib-spreading. Robotic assisted thoracic surgery (RATS) can avoid this throwback, combining the handling of open surgery with lesser invasiveness of thoracoscopy. Although literature has given strong evidences in favour of robotic lobectomies, data are still limited regarding segmentectomies performed with this technique. Moreover, no results are still available from the two ongoing randomized controlled trials comparing segmentectomy to lobectomy and so the latter represent the oncologically proper procedure for lung cancer along with lymph-node dissection. In this review we analyse the literature currently available on outcomes of lobar and sublobar anatomical resection performed by RATS, with a brief mention of the existing surgical techniques of port positioning and the costs of this procedure.

Anatomical analysis of variations in the bronchus pattern of the left upper lobe using three-dimensional computed tomography angiography and bronchography

“…With the use of thoracic thin-section CT, the detection rate of pulmonary nodules increases, and some research results (1)(2)(3)(4)(17)(18)(19)(20)(21) have shown that the prognosis of segmentectomy is no worse than that of lobectomy in patients with metastatic lung tumors or early lung cancer. The JCOG0802 study is a randomized controlled trial to confirm whether segmentectomy is not inferior to lobectomy in regard to prognosis.…”

“…In anatomical segmentectomy or subsegmentectomy, it is extremely important to master the types of the segmental and subsegmental bronchus. When planning a major lung resection the risk of conversion vary from 6.2% to 9.6%, being higher in video-assisted thoracic surgery (VATS) with unexpected bleeding as the leading cause (21,23). Accurate preoperative study (24,25) can reduce this risk to 2.6% and up to 0%, when a printed 3D model is available.…”

Lung segments from anatomy to surgery

“…A more automated variation of VATS is a robotic operation [75] in which the surgeon controls the robotic arms with the surgical instruments using foot pedals and a console [76].…”

Uptake of Video-Assisted Thoracoscopic Lung Resections Within the Veterans Affairs for Known or Suspected Lung Cancer

“…The uptake of robotic lung resections has increased since its widespread introduction into clinical practice in 2009 and 2010, most rapidly in the South. 26,30,31 An estimated 20% or greater of all lobectomies are currently performed robotically (data not shown). The use of robotic lung resections in the VA is unknown and merits further study.…”